Abstract
PurposeTo retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS).Materials and MethodsBetween 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher’s exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes.ResultsTechnical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3–110] vs 3.6±4.0[0.07–22] months, P<0.0001).ConclusionThe outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease.
Highlights
Post-irradiated carotid blowout syndrome (PCBS) is a dreaded complication that is associated with head-and-neck cancers (HNC) and its treatment [1,2,3,4,5]
The results according to endovascular methods were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435)
The results according to clinical severity were as follows: technical complication (15/47[31.9%] vs 4/49 [8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155)
Summary
Post-irradiated carotid blowout syndrome (PCBS) is a dreaded complication that is associated with head-and-neck cancers (HNC) and its treatment [1,2,3,4,5]. Clinical severity has been reported to influence the rebleeding rate of patients with PCBS, but this has not widely validated [14, 19]. In this retrospective study, we evaluated the clinical and technical factors associated with the technical, hemostatic and survival outcomes of endovascular management of PCBS in the HNC patients. We access the factors related to the outcomes and propose an algorithm of endovascular management of PCBS to highlight the decision of patient selection and post-procedural follow-up
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